Validity of the PHQ-9 and PHQ-2 to screen for depression in nationwide primary care population in Latvia.

BACKGROUND: Depression is highly underdiagnosed in primary care settings in Latvia. Screening for depression in primary care is potentially an efficient way to find undetected case s and improve diagnostics. We aimed to validate both a nine-item and two-item Patient Health Questionnaire (PHQ-9 and PHQ-2) in the Latvian and Russian languages in primary care settings using a representative sample in Latvia. MATERIALS AND METHODS: The study was carried out within the framework of the National Research Program BIOMEDICINE to assess the prevalence of mental disorders at 24 primary care facilities. During a 1-week period, all consecutive adult patients were invited to complete the PHQ-9 and PHQ-2. Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). RESULTS: There were 1467 patients who completed the PHQ-9 and the MINI. Overall, the PHQ-9 items showed good internal reliability (Cronbach's alpha 0.81 for Latvian version and 0.79 for Russian version of the PHQ-9). A cut-off score of 8 or greater was established for the PHQ-9 (sensitivity 0.75 and 0.79, specificity 0.84 and 0.80 for Latvian and Russian languages, respectively). For the PHQ-2, a score of 2 or higher (sensitivity 0.79 and 0.79, specificity 0.65 and 0.67 for Latvian and Russian languages) detected more cases of depression than a score of 3 or higher. CONCLUSIONS: We suggest GPs ask patients to respond to the first 2 questions of the PHQ-9. If their score is positive, the patients should then complete the PHQ-9.

Adaptation and validation of the Patient Health Questionnaire-9 to evaluate major depression in a primary care sample in Latvia.

BACKGROUND: Depression is one of the most common mental disorders in primary care settings and is often underdiagnosed and undertreated by general practitioners (GPs). To date, no depression screening instruments have been validated for use in primary care settings in Latvia. The aim of this study was to establish the validity and cutoff score of the Patient Health Questionnaire-9 (PHQ-9) among primary care patients in Latvia. MATERIALS AND METHODS: During a one-week period, all consecutive patients aged 18 years or older visiting their GP of health concerns at 6 primary care settings were invited to complete the PHQ-9 questionnaire in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (M.I.N.I.), which was conducted over the telephone by a psychiatrist less than 2 weeks after a primary care physician visit. RESULTS: In total, 324 patients were evaluated using the PHQ-9, 272 of whom agreed to be interviewed with the M.I.N.I. Overall, the PHQ-9 items showed good internal (Cronbach's alpha 0.84) reliability. A cutoff score of 10 was established for the PHQ-9 (sensitivity 86.49%, specificity 89.36%), correctly classifying 86.4% of patients with current depression. CONCLUSIONS: The PHQ-9 appears to be a reliable and valid instrument that can be used to diagnose major depression among Latvian and Russian speaking adults at the primary care level.

The 12-month prevalence of depression and health care utilization in the general population of Latvia.

BACKGROUND: This cross-sectional study aims to assess the 12-month prevalence of major and minor depression in the Latvian population, and to evaluate associated health care utilization. METHODS: Trained interviewers conducted face-to-face interviews with a multistage stratified probability sample of the Latvian general population, ages 15-64 (n=3003). Participants were interviewed using the depression module of the Mini International Neuropsychiatric Interview. Self-reported health care utilization and somatic illness were also assessed. Multinomial logistic regressions were applied. RESULTS: The 12-month prevalence of major depression was 7.9% (95%CI 7.0-8.9), while for minor depression it was 7.7% (95%CI 6.8-8.7). We did not find a substantial difference in the relative risk ratio (RRR 1.7 for female) for having major depression by gender. RRR of having major depression was higher for those who had used healthcare services six or more times (RRR 2.0), those who had three or more somatic disorders during the past 12 months (RRR 2.3), those who perceived their health status as being below average (RRR 8.3), and those who were occasional smokers (RRR 3.0). RRR of having minor depression was increased for those who had at least three somatic disorders (RRR 2.3), those who received disability pension (RRR 1.9), and those who perceived their health status to be below average (RRR 3.0). LIMITATIONS: The study was cross-sectional. Other psychiatric comorbidity was not assessed. CONCLUSIONS: This is the first population based study reporting the 12-month prevalence of depression in Latvia. Certain factors associated with depression have been found.

People with alcohol use disorders in specialized care in eight different European countries.

AIM: To provide a description of patients receiving alcohol treatment in eight different European countries, including the level of comorbidities and functional limitations. METHODS: Drinking behaviours, DSM-IV alcohol use disorder (AUD), mental and somatic comorbidities, disability and health services utilization of 1767 patients from various specialized treatment settings were assessed as representative for regions of eight European countries. Severity of alcohol dependence (AD) in terms of drinking level was compared with a large representative US sample. RESULTS: Patients in specialized care for AUDs showed high levels of consumption [average level of daily ethanol intake: 141.1 g, standard deviation (SD): 116.0 g], comorbidity [e.g. liver problems: 19.6%, 95% confidence interval (CI): 17.5-21.6%; depression: 43.2%, 95% CI: 40.7-45.8%; anxiety: 50.3%, 95% CI: 47.8-52.9%], disability and health services utilization (average number of nights spent in hospital(s) during the last 6 months: 8.8, SD: 19.5 nights). Severity of AD was similar to the US sample, but European men consumed on average more alcohol daily. CONCLUSIONS: High levels of consumption, somatic and mental comorbidities, disability and functional losses were found in this representative treatment sample, indicating that treatment was initiated only at severe stages of AUDs. Earlier initiation of treatment could help avoid some of the health and social burden.

Prevalence of and potential influencing factors for alcohol dependence in Europe.

Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.